Advocates for the home-care industry say they were stunned by Medicares new regulation for providing home oxygen therapy to seniors that they contend will adversely impact patients.
The groups primary complaint is that the guidance from the CMS focuses mostly on oxygen equipment, but does not account for the required range of services and the realities of providing quality oxygen therapy to Medicare beneficiaries, according to Tyler Wilson, president and chief executive officer of the Arlington, Va.-based American Association for Homecare, in a news release about the rule.
As a result of the new rule, oxygen providers must arrange for continued care for patients who move out of a providers service area. Also, providers must continue to furnish and maintain oxygen equipment for their patients after a 36-month rental period (which was established as part of the Deficit Reduction Act of 2005), but they will not receive payment from Medicare for those services. The CMS, however, will pay for oxygen contents and for limited maintenance.
Included in the 2009 physician-fee schedule, the new oxygen payment rules and supplier responsibilities are required by the Medicare Improvements for Patients and Providers Act of 2008. One provision in the rule that the association finds especially troubling is a requirement that oxygen providers must continue furnishing and maintaining their equipment for beneficiaries during any period of medical need for the remainder of the equipments useful lifetime (currently five years for oxygen equipment), even though Medicare reimbursement for those services ends after three years. According to a September 2006 report from the inspector generals office, about 46% of beneficiaries who began renting equipment in 2001 rented continuously for 12 months, while 22% rented for 36 months or longer.
Its a patient-safety issue, said Walt Gorski, the AAHs vice president of government affairs, about the CMS not paying for supplies after 36 months. Youre stunned when you see the lack of recognition of services that oxygen providers furnish to their beneficiaries from CMS perspective, he said.
In another provision, the CMS says oxygen suppliers must make arrangements for their beneficiaries to continue receiving their equipment even if those beneficiaries relocate.
CMS is requiring a provider to be responsible for a patient in the provision of oxygen no matter where that patient goes, Gorski said. Nowhere in the Medicare program do we know of a physician being responsible for life-sustaining care to the beneficiary. Mandating that oxygen providers are responsible for patients no matter where they go is an unworkable situation.
Homecare Concepts, Farmingdale, N.Y., provides oxygen therapy to beneficiaries in New York, says Homecares president and CEO Tom Ryan. Being in the New York metro area, we have a lot of snowbirds who go to Florida, Ryan said. For those months, I have to subcontract for a period. But when theyre gone for good, I have no control, referring to another providers services.
The rule has an open-comment period until Dec. 29 and takes effect Jan. 1, 2009.